Enhancing Facial HarmonyEnhancing Facial HarmonyORTHOGNATHIC SURGERY COMBINED WITH ORTHOGNATHIC SURGERY COMBINED WITH

FACIAL PLASTIC PROCEDURESFACIAL PLASTIC PROCEDURES

Samuel Benarroch Mahfoda Samuel Benarroch Mahfoda MD, DDS, OMSMD, DDS, OMS

Assistant ProfessorAssistant Professor

Oral & Maxillofacial Surgery Residency ProgramOral & Maxillofacial Surgery Residency Program

Woodhull Medical Center. New YorkWoodhull Medical Center. New York

Hospital Magallanes de Catia. CaracasHospital Magallanes de Catia. Caracas

ORTHOGNATHIC AND ORTHOGNATHIC AND ESTHETICESTHETIC PROCEDURES PROCEDURES

Create improvement while maintaining a natural appearance

PurposePurpose

Determine the type of cosmetic surgery Determine the type of cosmetic surgery procedures most frequently performed to procedures most frequently performed to enhance the result of orthognathic surgeryenhance the result of orthognathic surgery

DESIGN DESIGN

• Multicenter Multicenter

• Retrospective study Retrospective study

• Conducted from 1996 to 2005 Conducted from 1996 to 2005

PATIENT DISTRIBUTION

SEX AND AGE SEX AND AGE

SEX NUMBER %

MALE 358 28.6

FEMALE 894 71.4

TOTAL 1.252 100

dd

AGE NUMBER %

15 – 19 63 5.2

20 – 24 879 70.6

25 – 29 229 18.3

30 – 34 55 4.4

> 35 20 1.6

TOTAL 1.252 100

PATIENT DISTRIBUTIONDENTOFACIAL DEFORMITYDENTOFACIAL DEFORMITY

GROUP DEFORMITY NUMBER

I MAXILLA 510

II MANDIBLE 438

III BIMAXILAR 304

TOTAL 1.252

SURGICAL TECHNIQUESSURGICAL TECHNIQUES

• Maxilla Maxilla – Lefort ILefort I– High Lefort IHigh Lefort I– Segmental Segmental – RPERPE– Facial implantsFacial implants

• Mandible Mandible – BSSBSS– VORVOR– Distraction osteogenesisDistraction osteogenesis– Segmental Segmental

MA, F, 21. Feb. 1996MA, F, 21. Feb. 1996

• PROBLEM LISTPROBLEM LIST– Nasal deformityNasal deformity– Facial asymmetryFacial asymmetry– Mandibular deviationMandibular deviation– Thinner upper lip Thinner upper lip

• SURGICAL PLAN SURGICAL PLAN – Closed basic rhinoplastyClosed basic rhinoplasty– Mandibular osteotomyMandibular osteotomy– Upper Lip plastyUpper Lip plasty

CH, F, 23. Feb. 1997CH, F, 23. Feb. 1997

• PROBLEM LISTPROBLEM LIST– Nasal deformityNasal deformity– Full inframalar contoursFull inframalar contours– V.M.E.V.M.E.– Drooping lower lip Drooping lower lip – AP Chin deficiencyAP Chin deficiency– Neck lipomatosisNeck lipomatosis

• SURGICAL PLAN SURGICAL PLAN 2 Phases2 Phases– Rhinoseptoplasty Rhinoseptoplasty – Buccal fat pad removal Buccal fat pad removal – Maxillary impactionMaxillary impaction– Lower Lip plastyLower Lip plasty– Chin advancementChin advancement– Neck liposuctionNeck liposuction

MM, F, 20. April,1999MM, F, 20. April,1999

PROBLEM LISTPROBLEM LIST– Nasal deformityNasal deformity– Full inframalar contoursFull inframalar contours– Gumming smileGumming smile– Small and round face Small and round face – AP mandible deficiencyAP mandible deficiency– AP and vertical chin deficiencyAP and vertical chin deficiency– Drooping lower lip Drooping lower lip SURGICAL PLAN 3 PHASESSURGICAL PLAN 3 PHASES– Intraoral mandible distraction Intraoral mandible distraction

osteogenesisosteogenesis– RhinoplastyRhinoplasty– Maxillary Anterior Maxillary Anterior

gingivoplasty gingivoplasty – Buccal fatpad removalBuccal fatpad removal– Lower lip plastyLower lip plasty– Vertical augmentation and Vertical augmentation and

advancement of the chin advancement of the chin

LR, F, 21. July, 2000LR, F, 21. July, 2000

• PROBLEM LISTPROBLEM LIST– Ocular surface diseaseOcular surface disease– Nasal deformityNasal deformity– Lower third vertical augmentationLower third vertical augmentation– Upper and lower lip deformityUpper and lower lip deformity– Maxillary transverse collapseMaxillary transverse collapse– AP chin deficiencyAP chin deficiency– Vertical chin augmentationVertical chin augmentation

• SURGICAL PLAN 2 PHASESSURGICAL PLAN 2 PHASES– Maxillary assisted expansionMaxillary assisted expansion– Maxillary posterior impactionMaxillary posterior impaction– Mandible BSSMandible BSS– Lip pastiesLip pasties– Vertical reduction of the chinVertical reduction of the chin– AP chin advancement AP chin advancement

RESULTSRESULTSGroup I

PROCEDURE %

Genioplasty 57.3

Rhinoplasty 26.4

Blepharoplasty 5.6

Lip-plasty 16.4

Buccal fat pad removal

13.6

Submental liposuction

8.1

Malar augmentation 0.9

RESULTSRESULTS

Group IIPROCEDURE %

Genioplasty 60.2

Rhinoplasty 54.5

Blepharoplasty 3.4

Lip-plasties 19.1

Buccal fat pad removal

17

Submental liposuction

2.3

Malar augmentation 5.7

RESULTSRESULTS

Group IIIPROCEDURE %

Genioplasty 53.7

Rhinoplasty 29.6

Blepharoplasty 3.7

Lip-plasty 24.1

Buccal fat pad removal

22.2

Submental liposuction

5.5

Malar augmentation 0

OVERALL RESULTSOVERALL RESULTS

PROCEDURE %

Genioplasty 57.5

Rhinoplasty 36.9

Blepharoplasty 4.4

Lip-plasty 20.6

Buccal fat pad removal

13.1

Submental liposuction

5.1

Malar augmentation

2.4

DISCUSSION DISCUSSION

• There is great variability (sex, race) and There is great variability (sex, race) and subjectivity (eye of the beholder) in appreciation subjectivity (eye of the beholder) in appreciation of facial beauty of facial beauty

• The advantages of combined procedures include The advantages of combined procedures include a single recovery period, reduced surgery costs, a single recovery period, reduced surgery costs, and faster patient gratificationand faster patient gratification

• The results of this retrospective review does not The results of this retrospective review does not indicate that the combination of cosmetic indicate that the combination of cosmetic surgical procedures increases morbiditysurgical procedures increases morbidity

DISCUSSION DISCUSSION

• The correction of the The correction of the dominant negative traits, is it enough?

• When should we stop?

CONCLUSIONCONCLUSIONFacial harmony will not appear as Facial harmony will not appear as

“beautiful” unless the combination of “beautiful” unless the combination of different facial procedures different facial procedures

Orthognathic + Cosmetic + Orthognathic + Cosmetic + Esthetics GuidanceEsthetics Guidance

ESTETHICESTETHIC

Patient's needs Surgeon's satisfaction

Thank you for your kind attentionThank you for your kind attention

Enhancing Facial HarmonyEnhancing Facial Harmony

ORTHOGNATHIC SURGERY COMBINED WITH FACIAL PLASTIC PROCEDURESORTHOGNATHIC SURGERY COMBINED WITH FACIAL PLASTIC PROCEDURES

Samuel Benarroch Mahfoda MD, DDSOral & Maxillofacial SurgeryOral & Maxillofacial Surgery